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CLINICAL RESEARCH: VALVULAR HEART DISEASE

Effect of Beta-Blocker Therapy on Survival in Patients With Severe Aortic Regurgitation

Results From a Cohort of 756 Patients

Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California

Manuscript received December 14, 2008; revised manuscript received February 13, 2009, accepted February 24, 2009.

^_* Reprint requests and correspondence: Dr. Ramdas G. Pai, Division of Cardiology, 11234 Anderson Street, Room 4414, Loma Linda University Medical Center, Loma Linda, California 92354 (Email: ramdaspai{at}yahoo.com).

Objectives: We sought to investigate the effect of beta-blocker (BB) therapy on survival in patients with severe aortic regurgitation (AR).

Background: Beta-blockers are thought to be contraindicated in patients with AR because a slower heart rate increases the duration of diastole during which AR occurs. But AR also causes neuroendocrine activation similar to a heart failure state for which BBs are potentially beneficial.

Methods: This is an observational study. Our echocardiographic database was screened for patients with severe AR. Detailed chart reviews were performed for clinical, demographic, and therapeutic data. Mortality data were obtained from the Social Security Death Index and analyzed as a function of BB therapy.

Results: Three hundred fifty-five (47%) of the 756 patients with severe AR were on a BB; mean age 61 ± 18 years and ejection fraction was 54 ± 19%. Over a mean follow-up of 4.5 years, BB therapy was associated with a higher survival rate (1- and 5-year survival rates of 90% and 70%, respectively) compared with those without (1- and 5-year survival rates of 75% and 55%, respectively) (p = 0.0009). The Cox regression model showed that BB therapy was an independent predictor of better survival after adjusting for age, sex, heart rate, hypertension, coronary artery disease, diabetes mellitus, heart failure, renal insufficiency, ejection fraction, and aortic valve replacement (hazard ratio: 0.74, 95% confidence interval: 0.58 to 0.93, p = 0.01). The survival benefit of BB therapy was further supported by propensity score analysis.

Conclusions: This observational study strongly suggests that BB therapy is associated with a survival benefit in patients with severe AR.

Key Words: aortic regurgitation • beta-blocker • survival

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   AR = aortic regurgitation   AVR = aortic valve replacement   BB = beta-blocker   CAD = coronary artery disease   EF = ejection fraction   LV = left ventricular

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